Therapeutic approaches to diastolic dysfunction

Janardhanan, Rajesh; Desai, Akshay S.; Solomon, Scott D.

doi:10.1007/s11906-009-0048-z

Cited by 15 publications

(7 citation statements)

References 65 publications

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“…66 It should be recognized that these functional parameters may be confounded by myocardial processes that parallel the development of fibrosis, and may not be optimal for this purpose. 78 …”

Section: Tissue Characterizationmentioning

confidence: 99%

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Marwick

Gillebert

Aurigemma

et al. 2015

Journal of the American Society of Echocardiography

410

345

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Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.

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Section: Tissue Characterizationmentioning

confidence: 99%

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Marwick

Gillebert

Aurigemma

et al. 2015

Journal of the American Society of Echocardiography

410

345

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“…Patients with longstanding or poorly controlled HTN are at increased risk for developing left ventricular hypertrophy (LVH) and diastolic dysfunction (2). LVH is an independent risk factor for cardiovascular morbidity and mortality in hypertensive patients (3, 4).…”

Section: Introductionmentioning

confidence: 99%

Increased Extracellular Volume and Altered Mechanics Are Associated With LVH in Hypertensive Heart Disease, Not Hypertension Alone

Kuruvilla

Janardhanan

Antkowiak

et al. 2015

JACC: Cardiovascular Imaging

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150

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Objectives To assess the relationship between extracellular volume (ECV), native T1, and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH), hypertensive patients without LVH (HTN Non-LVH) and normotensive controls. Background Diffuse myocardial fibrosis in HTN LVH patients, as reflected by increased ECV and native T1, may be an underlying mechanism contributing to increased cardiovascular risk when compared to HTN Non-LVH subjects and controls. Furthermore increased diffuse fibrosis in HTN LVH subjects may be associated with reduced peak systolic and early diastolic strain rate when compared to the other two groups. Methods T1 mapping was performed in 20 HTN LVH (55±11 years), 23 HTN Non-LVH (61±12) and 22 control (54±7) subjects on a Siemens 1.5T Avanto using a previously validated MOLLI pulse sequence. T1 was measured pre-contrast and 10, 15 and 20 minutes following injection of 0.15 mmol/kg Gd-DTPA, and the mean ECV and native T1 were determined for each subject. Measurement of circumferential strain parameters were performed using cine displacement encoding with stimulated echoes (DENSE). Results HTN LVH subjects had higher native T1 when compared to controls (p < 0.05). HTN LVH subjects had higher ECV when compared to HTN Non-LVH subjects and controls (p < 0.05). Peak systolic circumferential strain and early diastolic strain rate were reduced in HTN LVH subjects when compared to HTN Non-LVH subjects and controls (p < 0.05). Increased levels of ECV and Native T1 were associated with reduced peak systolic and early diastolic circumferential strain rate across all subjects. Conclusions HTN LVH patients had higher ECV, longer native T1 and associated reduction in peak systolic circumferential strain and early diastolic strain rate when compared to HTN Non-LVH and control subjects. Measurement of ECV and native T1 provide a non-invasive assessment of diffuse fibrosis in hypertensive heart disease.

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“…Patients with longstanding hypertension are at increased risk for developing left ventricular hypertrophy (LVH) and diastolic dysfunction [1]. Arterial hypertension represents one of the most common risk factors for the development of heart failure, conferring approximately a twofold increased risk in men and a threefold risk in women relative to normotensive subjects [2].…”

mentioning

confidence: 99%

Imaging in hypertensive heart disease

Janardhanan

Kramer

2011

Expert Review of Cardiovascular Therapy

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Hypertensive heart disease is the target organ response to arterial hypertension. Left ventricular hypertrophy represents an important predictor for cardiovascular events. Myocardial fibrosis, a common end point in hypertensive heart disease, has been linked to the development of left ventricular hypertrophy and diastolic dysfunction. Echocardiography is clinically useful in the detection of left ventricular hypertrophy and the assessment of diastolic function. Although echocardiography is more widely available, cardiac magnetic resonance has been demonstrated to be more reproducible for the estimation of left ventricular mass. Future developments in cardiac magnetic resonance techniques may facilitate the quantification of diffuse fibrosis that occurs in hypertensive heart disease. Thus, advances in cardiac imaging provide comprehensive, noninvasive tools for imaging left ventricular hypertrophy, diastolic dysfunction, myocardial fibrosis and ischemia observed in hypertensive heart disease. The objective of this article is to summarize the state-of-the-art and the future of multimodality imaging of hypertensive heart disease.

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Therapeutic approaches to diastolic dysfunction

Cited by 15 publications

References 65 publications

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Increased Extracellular Volume and Altered Mechanics Are Associated With LVH in Hypertensive Heart Disease, Not Hypertension Alone

Imaging in hypertensive heart disease

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